Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105306

Marc N. Elliott, PhD¹, Shulamit Bernard, PhD², Alan Zaslavsky, PhD³, Lisa Carpenter, MS², and Paul Cleary, PhD³. (1) RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, 310-393-0411, elliott@rand.org, (2) Health Care Quality Program, RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, (3) Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115

Study Design: Four annual cross-sectional surveys of nationally representative samples of Medicare beneficiaries. We analyzed effects of coverage type (Medicare Advantage=MA, Fee-for-service=FFS) on reports of health care experiences and how these effects vary by health status, using linear models that adjust for education, age, proxy response, and county of residence. Measures are six outcomes from the Consumer Assessments of Health Plans (CAHPS®) survey: three scales (Getting Needed Care, Good Communication, Getting Care Quickly), a 0-10 rating (Care Received), and two dichotomous measures of preventative services (received flu shot, received pneumonia shot). Comparisons were made within strata of respondents with “Poor/Fair”, “Good”, or “Very Good/Excellent” self-reported health status.

Population Studied: 610,231 MA and 220,584 FFS beneficiaries residing in the 617 counties in 40 states where beneficiaries had a choice between MA and FFS for 2000 through 2003. These counties represent more than 90% of the MA population and about half of the FFS population in any given year.

Results: Beneficiaries reported significantly (p<.05, usually p<.001) better experiences with FFS than with MA for 38 of 48 comparisons (4 years x 4 scales x 3 health strata) of scales and ratings, including 15 of 16 for beneficiaries rating their health as “fair” or “poor.” The only two comparisons for which beneficiaries reported significantly better experiences with MA than with FFS were for beneficiaries rating their health as “very good” or “excellent” in 2000. Differences in favor of FFS tended to be largest for beneficiaries who described their health as “fair” or “poor” for all measures but “Getting Care Quickly.” These differences are fairly small, with median differences of 0.03 to 0.22 standard deviations for the four outcomes. The largest effects exceed 0.20 standard deviations for three of four measures and exceed 0.50 standard deviations for Getting Care Quickly.

In all 24 comparison beneficiaries received immunizations significantly (p<.001) more often in MA than in FFS, with differences of 4-10%. For pneumonia shots, the MA advantage over FFS was greatest for beneficiaries in “fair” or “poor” health.

Conclusions: Health Care experiences are quite positive for both MA and FFS beneficiaries, but are somewhat more positive for FFS beneficiaries for ratings and scales and somewhat better for MA for immunizations. Differences are greatest for those in “fair” or “poor” health. Efforts should be undertaken to improve access to care in MA and preventative care in FFS Medicare.

Learning Objectives:

• Assess whether the differences between health care experiences reported by beneficiaries in Medicare managed care (Medicare Advantage, MA) and beneficiaries in Medicare fee-for-service (FFS) varies by self-rated health status.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.